50 things to know about athenahealth, Cerner, Epic, McKesson & Meditech

From an organization founded in 1997 to one that has been around for nearly two centuries, the major EHR vendors come in all shapes and sizes.

Here are 50 things to know about five of the market's dominant EHR vendors.

Note: The vendors are arranged alphabetically.

1. Jonathan Bush — nephew of U.S. President George H.W. Bush and cousin of President George W. Bush — and Todd Park founded the Watertown, Mass.-based company in 1997. Today, Mr. Bush serves as CEO, president and chairman of the board of directors; Mr. Park, who no longer holds a position at athenahealth, went on to serve as U.S. chief technology officer during the Obama administration.

2. There are roughly 88,000 providers and 86 million patients on athenahealth's network. A few recent contracts include Tandigm Health — a value-based healthcare company supporting primary care physicians — implementing athenahealth's population health management tool and Michigan State University HealthTeam — the multispecialty faculty group practice of the university — implementing athenahealth's suite of services.

3. In 2016, athenahealth reported total revenue of $1.08 billion — a 17 percent increase compared to the $924.7 million it reported in 2015. In a list of health technology vendors ranked by highest revenues, IDC Health Insights named athenahealth the eighth highest earner compared to other companies that derive more than one-third of their revenue from healthcare payers and providers.

4. For three years running, athenahealth has ranked as the top vendor in user satisfaction among physician groups with six to 10 physicians and groups with 11 to 25 physicians, according to a Black Book poll. In the 2016 Black Book Inpatient EHR Surveys, athenahealth clients were also identified as "most loyal," meaning the company's clients intend to maintain their business relationship and have a positive attitude toward the vendor.

5. Only 22 of the 4,474 hospitals participating in the Medicare EHR Incentive Program use athenahealth's EHR technology, according to ONC data from July 2016, making it tied for the 36th most-used certified health IT vendor hospitals report for the program. However, ONC also notes that only 10 vendors, including athenahealth, supply 98 percent of hospitals with their certified IT technology, based on HHS' 2014 Edition Health Information Technology Certification Criteria.

6. In July 2016, the company announced its MIPS Guarantee program, which reimburses clients who face a downward payment adjustment under the Merit-based Incentive Payment System. The program is meant to help clients using the athenaOne services suite perform at or above the national performance threshold set by CMS, therefore avoiding any payment penalties on their Medicare Part B fee schedule.

7. One of athenahealth's core initiatives is its "More Disruption Please" program, which connects startups with the opportunity to sell to athenahealth clients. The program has collaborated with companies like Relaymed, which connects point-of-care devices to EHRs, and SnapMD, a telemedicine provider.

8. Another one of the company's primary focuses is interoperability. The company is a founding member of the CommonWell Health Alliance, a nonprofit and independent organization focused on developing and deploying interoperability solutions. Athenahealth, along with other major IT vendors like Epic and Cerner, also committed to the Interoperability Pledge, which HHS Secretary Sylvia Mathews Burwell announced during HIMSS16 in February 2016.

9. In June 2013, athenahealth said it would move the majority of its Georgia operations from Alpharetta to Atlanta, and at the start of 2017, the company announced plans to expand its workforce in Atlanta to almost 1,000 employees by 2018. With this new expansion, athenahealth — which currently utilizes 98,000 square feet of space at Ponce City Market in Atlanta — will tack on an extra 40,000 square feet of space to its offices.

10. Athenahealth's CEO and cofounder, Mr. Bush, has made headlines for his outspoken views on both national politics and healthcare management. In a speech to Massachusetts Republicans in June 2016, he publicly stated he would not vote for Donald Trump, who has since won the national election. In an April 2016 interview with Bloomberg, he voiced that — although he is critical of the ACA — he credits some of athenahealth's growth the ACA.

11. Neal Patterson, Cliff Illig and Paul Gorup founded Kansas City, Mo.-based Cerner in 1979. The company's name, according to the Cerner website, is derived from a Latin word meaning "to discern." Today, Mr. Patterson serves as chairman of the board and CEO, while Mr. Illig serves as vice chairman of the board. Mr. Gorup, who left Cerner in 1987 but returned in 1999, was named to Epiq's board of directors last year. Cerner employs more than 24,000 people worldwide.

12. The company's technologies are licensed at more than 25,000 facilities in more than 35 countries. A few recent contracts include Lynchburg, Va.-based Centra Health selecting Cerner for its five hospitals, more than 50 ambulatory and long-term care facilities and health plan, and the Department of Defense awarding a $74 million data hosting contract to Leidos, Cerner and Accenture for the DoD's EHR.

13. Cerner is currently building its seventh campus. Dubbed the Innovations Campus, the development is projected to reach $4.5 billion and will house 16,000 Cerner employees. Each of the 15 streets on the Kansas City-based campus' road system will be named after a healthcare or technology leader.

14. Cerner came in No. 2 on IDC Health Insights' 2016 HealthTech Rankings, which highlight companies that derive more than one-third of their revenue from healthcare payers and providers. Cerner also claims the largest market share in the EMR industry, according to a Kalorama Information report.

15. In the third quarter of fiscal year 2016, Cerner reported revenue of $1.185 billion — a 5 percent decrease compared to the $1.28 billion it reported in the third quarter of FY 2015. More recently, Cerner reported full-year 2016 revenue of $4.8 billion, which is 8 percent higher than its 2015 reported revenue of $4.43 billion.

Speaking of the revenue cycle business: In September 2016, Cerner appointed Jeff Hurst as the first-ever senior vice president of revenue cycle management and president for RevWorks, Cerner's revenue management services unit.

16. Cerner's loyalty rankings increased from 88 percent in 2015 to 96 percent in 2016, and 95 percent of its clients advocate for peers to purchase Cerner products, according to the 2016 Black Book Inpatient EHR Surveys. However, not all customers have been pleased. Vancouver Island Health Authority facilities in Canada made headlines after physicians reverted to using pen and paper to complete orders soon after their March 2016 Cerner implementation, claiming that the EHR system randomly lost, buried or changed orders for drugs and diagnostic tests.

17. Cerner has been the target of four lawsuits regarding employees' overtime wages. The latest lawsuit, which seeks unspecified damages, was filed in 2016 and alleges help desk workers who offer technical support were expected to work at least 48 hours a week, but they did not receive overtime pay. In another lawsuit, two former Cerner employees allege the company miscalculated overtime pay for potentially thousands of workers.

18. One of Cerner's core initiatives is interoperability. The company is a founding member of the CommonWell Health Alliance, a nonprofit and independent organization focused on developing and deploying interoperability solutions. Cerner's website offers the Interoperability Ticker, an interactive map that tracks clinical transactions, pharmacy transactions, health information exchanges and Cerner interoperability solutions in use across the country.

19. Cerner is the most-used certified health IT vendor reported by hospitals participating in the Medicare EHR Incentive Program. Based on ONC data from July 2016, 1,029 hospitals report using Cerner's EHR technology; this is 76 more hospitals than the second most common health IT vendor that hospitals report using, which is Meditech.

20. Cerner's CEO and cofounder, Mr. Patterson, has continued to stay involved in the company's operations despite his 2016 diagnosis of soft tissue cancer. In November 2016, he made a surprise speech at the Cerner Health Conference in Kansas City, during which he discussed his personal journey through the healthcare system, saying: "I realized God had a sense of humor: He put me in a place undergoing an EHR conversion."

21. Epic was founded in a basement in 1979 by Judy Faulkner. With 1.5 employees, the company was originally called Human Services Computing but rebranded as Epic Systems in 1983, according to Isthmus. In its early stages, Epic and the precursor to American Girl utilized the same basement in a Madison, Wis., apartment building.

22. Ms. Faulkner, a programmer, initially had no intention of founding a company. But after requests from clients, she chose to start a company based on the clinical data management system she'd created. At a meeting during the company's early stages, a client grabbed a dictionary and looked up the definition of "epic": "the glorious recounting of a nation's events." The group liked the name and decided to go with it. "Like the 'Iliad' or the 'Odyssey,' our electronic health records chronicle the story of a patient's healthcare over time," Epic's website quips.

23. Ms. Faulkner serves as Epic's CEO. As of Jan. 17, 2017, Forbes valued her worth at $2.2 billion. Last year, Ms. Faulkner ranked No. 3 on Forbes' list of "America's Richest Self-Made Women" and No. 79 on Forbes' list of "Richest People in Tech."

In 2015, Ms. Faulkner pledged 99 percent of her wealth to philanthropy by joining the Giving Pledge, an initiative in which some of the world's wealthiest individuals pledge to donate the majority of their assets to philanthropy.

24. Located in Verona, Wis. — approximately 11 miles south of Madison — Epic's headquarters is unique. The company hired the architects who designed Disneyland to blueprint a creative campus, according to The Boston Globe. A sculpture of Humpty Dumpty sits on a wall near the entrance to the headquarters. Each section of the campus has a different theme, from farming to castles to New York City's Grand Central Station. The campus also features an enormous slide and treehouse for meetings.

Epic has even been lauded for its imaginative campus. In October 2016, the American Institute of Architects gave Epic an honorable mention in its annual TAP/CCA Innovation Awards. The Epic Deep Space Auditorium — which can seat up to 11,400 and was designed by Minneapolis-based Cuningham Group — received an honorable mention in the stellar design category.

25. Epic's campus is not only unique in its design — it's also unique in its sustainability efforts. To generate energy, Epic installed six wind turbines and 18 acres of solar panels. Its campus includes almost 350 acres of farmland that Epic lends out to farmers. For heating and cooling its buildings, Epic utilizes its thousands of miles of underground geothermal pipes.

26. Every five years, Epic employees are eligible for a month-long paid sabbatical. If employees decide to spend their time off in a country they've never been to, Epic will fund the trip for the employee and one guest. Thus far, Epic employees have headed out on more than 3,000 trips to more than 100 countries, including Israel, Germany, Zimbabwe, Japan and the Bahamas.

27. Approximately 19 million patients across the globe currently have a record in Epic's EHR system. Epic's software is used in a variety of clinical settings, including community hospitals, retail clinics, rehabilitation centers, academic medical centers and independent practices. Patients can access the software from their homes and their mobile devices.

28. Epic claims all of its customers currently interoperate and exchange 1.3 million patient records each day with other EHR vendors, government agencies, registries and each other.

Epic is a founding member of Carequality, an interoperability framework that's a collaborative of public and private organizations. However, Epic has refrained from joining certain marketplace collaborations that claim to be dedicated to interoperability, such as the CommonWell Health Alliance.

29. Epic clients appear less satisfied with and more "trapped" in their vendor relationships, according to the 2016 Black Book Inpatient EHR Surveys. The surveys gathered responses from EHR vendors between the second quarter of 2015 and the first quarter of 2016. Epic was one of the vendors in the "trapped" quadrant, which Black Book classified as customers with the intent to continue business with the vendor but dissatisfaction with some important aspect of the relationship.

The overall loyalty percentage for Epic customers dropped from 89 percent in 2015 to 80 percent in 2016. In addition, 98 percent of Epic clients reported they were renewing their current contracts yet only 72 percent said they would advocate for peers to also purchase the product.

30. At Epic's 2016 Users Group Meeting, Ms. Faulkner addressed two new initiatives the company has launched.

First, Epic partnered with AmericanUniversity of Beirut in Lebanon to help refugees with their healthcare. Through their collaboration, Epic and AUB are planning a system in which patients in Lebanon would receive their basic health information on a thumb drive and be able to share that information with patients and organizations in other countries.

In addition, Ms. Faulkner said Epic is launching a program to support federally qualified health centers. Epic will offer free licenses and maintenance to healthcare systems that supply tertiary, specialty and inpatient care to local FQHCs. For FQHCs that can't afford or are too busy to install Epic, Epic will be available to help with the installs. For health systems that have already extended Epic to an FQHC, Ms. Faulkner said Epic will work with them to potentially reduce the cost of software maintenance.

31. McKesson was founded in New York City in 1833 by John McKesson and Charles Olcott as a therapeutic drug and chemical wholesale company. In 1853, a new partner, Daniel Robbins, joined the company. Through the years, McKesson altered its focus multiple times and acquired various companies, including General Medical and HBO & Co. Today McKesson stands as the oldest healthcare company in the U.S.

32. John H. Hammergren currently serves as chairman, president and CEO of McKesson, which is now based in San Francisco. He was named president and CEO in 2001 and chairman in 2002.

33. The company has two primary businesses: McKesson Distribution Solutions and McKesson Technology Solutions. Through those businesses, McKesson works with providers, manufacturers, pharmacies and health plans. As part of its Distribution Solutions business, McKesson delivers one-third of all pharmaceuticals used each day in North America. More than 200,000 physicians utilize McKesson's technology and services, and 76 percent of hospitals with more than 200 beds are McKesson customers.

34. However, McKesson's offerings  aren't limited to products in the pharmaceutical and technology sectors. The company offers a plethora of services across numerous sectors. A small sampling of McKesson's offerings includes revenue cycle services for physicians and for radiology, a Homecare MobileCare solutionprescription labeling and printing services, a Blood Bank solution and gift card processing services.

35. Last May, McKesson released its fiscal year 2016 financial results. Between the year ended March 31, 2015 and the year ended March 31, 2016, McKesson's revenue increased 6.6 percent from $179 billion to $190.9 billion. During the same period, McKesson's net income increased 49.7 percent from $1.5 billion to $2.3 billion.

36. According to July 2016 ONC data, 462 hospitals that attest to meaningful use utilize McKesson's EHR technology, making it the fifth most common health IT vendor. Cerner, Meditech, Epic and Evident have more hospital customers.

37. As part of the 2016 Black Book Inpatient EHR Surveys, a loyalty index split degrees of loyalty into four quadrants: "most loyal," "reachable," "trapped" and "top risk." McKesson was the only vendor placed in the "reachable" sector, which is characterized by clients with a good attitude about working with the company but do not have plans to enhance the business relationship.

38. McKesson was a founding member of the CommonWell Health Alliance, an organization dedicated to improving interoperability in the health IT realm. Other founding members include Allscripts, athenahealth, Cerner, Evident, Greenway Health and Sunquest. Additionally, McKesson committed to the Interoperability Pledge, which presents healthcare providers with three core commitments regarding interoperability and was announced at HIMSS16.

39. After a months-long process, McKesson and Change Healthcare have almost closed on the merger of their business units. In June 2016, the companies unveiled plans to combine McKesson's IT business unit and all of Change Healthcare's businesses into a separate company focused on healthcare technology. In September, the Department of Justice began examining potential antitrust concerns regarding the proposed merger, but the DOJ ended its investigation by late December. In January, the companies said the new company would retain the Change Healthcare name. Through the merger, which is expected to close in the first half of this year, McKesson will own 70 percent of the new company and Change Healthcare stockholders will own the remaining 30 percent.

40. McKesson has been working on a number of acquisitions recently. In December 2016, it wrapped up its $2.1 billion acquisition of Mississauga, Ontario, Canada-based Rexall Health. Through the transaction, McKesson gained ownership of Rexall's 470 pharmacies. Last month, McKesson announced its $1.1 billion pending acquisition of CoverMyMeds, an electronic prior authorization service provider. The acquisition agreement also includes a maximum of $300 million of consideration, which is dependent on CoverMyMeds' future fiscal performance.

41. While A. Neil Pappalardo was working at Boston-based Massachusetts General Hospital in 1964, he created MGH Utility Multi-Programming System, or MUMPS, a medical software language. His interest in healthcare technology led him to found Medical Information Technology, or Meditech, in 1968. The company officially opened for business in August of the next year.

42. Howard Messing serves as president and CEO of Westwood, Mass.-based Meditech. He's held the president position since 2002 and CEO position since 2010. Lawrence Polimeno, Meditech's first employee, is the company's vice chairman, a role he's held since 2002. Mr. Pappalardo currently serves as Meditech chairman.

43. Meditech provides its EHR solution to more than 2,300 institutions around the globe. Approximately 650 of its customers are internationally based across 22 countries, including Australia, the Bahamas, Canada, Ireland, Kuwait and Mozambique.

44. Meditech's latest product offerings include the 6.1 EHR platform and the web ambulatory solution. To date, more than 360 Meditech customers have signed up for the 6.1 platform, and 190 of them have gone live. More than 110 Meditech customers have signed up for its web ambulatory product, and six have gone live.

45. More than 2,000 providers using Meditech have attested to meaningful use. According to July 2016 ONC data, 953 hospitals that attest to MU use Meditech's EHR technology, making it the second most common health IT vendor.

46. In terms of interoperability, Meditech is a member of the CommonWell Health Alliance, a collaboration that seeks to enhance interoperability in health IT. It was founded by several other top IT vendors, including Allscripts, athenahealth, Cerner, Evident, Greenway Health, McKesson and Sunquest.

47. Meditech clients appear less satisfied with and more "trapped" in their vendor relationships, according to the 2016 Black Book Inpatient EHR Surveys. The surveys gathered responses from EHR vendors between the second quarter of 2015 and the first quarter of 2016. Meditech was one of the vendors in the "trapped" quadrant, which Black Book classified as customers with the intent to continue business with the vendor but dissatisfaction with some important aspect of the relationship.

48. Meditech invests in learning and higher education. In 2010, the vendor launched a relationship with Boston-based Northeastern University to integrate its EHR software into the classroom setting for health science students. Three years later, Meditech was named "Employer of the Year" at Bridgewater (Mass.) State University. Meditech currently employs more than 200 BSU graduates.

49. Hospitals using Meditech's EHR have gained recognition in the health IT world. In 2015, two Meditech customers received the HIMSS Nicholas E. Davis Award of Excellence, which recognizes Stage 6 or 7 hospitals. The same year, numerous Meditech organizations — including Sioux Falls, S.D.-based Avera Health and Prince Frederick, Md.-based Calvert Memorial Hospital — were named to Hospitals & Health Networks' Health Care's Most Wired list.

50. Meditech recently reported its financial results for 2016. The company's total revenue for existing and new customers was $462.3 million in 2016, a 2.8 percent decrease from the $475.5 million reported in 2015. Meditech's 2016 net income was $72.9 million. This is nearly a 4 percent increase from the $70.1 million the company reported in 2015.

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