IDC MarketScape: U.S. Health Information Exchange Platform Solutions 2012, Vendor Assessment, Doc #H1235816, positions InterSystems, and our HealthShare strategic informatics platform, as a leader in the market.

1. IDC MarketScape: U.S. Health Information
Exchange Platform Solutions 2012
Vendor Assessment
IDC Health Insights: Connected Health IT Strategies
V E N D O R A S S E S S ME N T #HI235816
L yn n e A . D u n b r a c k
www.idc-hi.com
IN THIS EXCERPT
The content for this excerpt was taken directly from the IDC
MarketScape: "IDC MarketScape: U.S. Health Information Exchange
F.508.988.7881
Platform Solutions 2012 Vendor Assessment" by Lynne A. Dunbrack
(Doc # HI235816). All or parts of the following sections are included
in this excerpt: IDC Health Insights Opinion, In This Study, Situation
Overview, Future Outlook, and Essential Guidance. Also included is
Figure 1.
P.508.935.4445
IDC HEALTH INSIGHTS OPINION
The health information exchange (HIE) market continues to evolve,
Global Headquarters: 5 Speen Street Framingham, MA 01701 USA
with the focus shifting from connecting the ecosystem to exchange
data and qualify for meaningful use incentives to turning data into
"actionable information" that enables emerging accountable care or
collaborative care initiatives. Key findings include:
● To address the business and technical requirements of accountable
care, in addition to providing core HIE technologies, vendors are
developing, partnering, or acquiring analytics, collaborative care,
and patient engagement technologies.
● Market consolidation among HIE vendors continues. Since Vendor
Assessment: Industry Short List for Health Information Exchange
Technologies (IDC Health Insights #HI222529, March 2010) was
published, seven HIE vendors have been acquired or have merged.
● New entrants to the market include payers and telecommunication
companies. Aetna and Optum have entered the HIE technology
market through their acquisitions of Medicity Inc. and Axolotl
Corp., respectively. In addition, Medecision, which acquired Hx
Technologies Inc. in 2009, is owned by Health Care Service Corp.
AT&T and Verizon partnered with technology vendors to launch
their respective HIE solutions in 2011 and 2010, respectively.
July 2012, IDC Health Insights #HI235816e
IDC Health Insights: Connected Health IT Strategies: Vendor Assessment

2. ● Platform as a service will increasingly play an important role in
delivering HIE capabilities. The IT requirements for health
information organizations (HIOs) and evolving care delivery and
reimbursement models are too extensive for any one vendor to
satisfy. Thus creating an ecosystem of strategic partnerships will be
critical moving forward.
IN THIS STUDY
This IDC MarketScape provides an evaluation of 16 vendors that
provide HIE platform solutions. Vendors were selected on the basis of
estimated market share and potential for growth. The IDC
MarketScape vendor assessments for HIE technology are not all
inclusive as there are other vendors that provide either a packaged or
platform solution for HIE. Additional HIE vendors are covered in IDC
MarketScape: U.S. Health Information Exchange Packaged Solutions
2012 Vendor Assessment (IDC Health Insights #HI235830, July 2012),
which covers 10 vendors that offer a packaged solution for HIE. See
the Appendix section of this report for a listing of packaged solutions
covered in that report. There are 4 vendors that are covered in both
reports because they provide both a packaged and a platform solution.
In all, 22 vendors were evaluated for HIE technologies.
Platform Solutions Defined
The term platform has been overused, and unfortunately with little
technical precision, by product marketing teams to make their products
sound more robust. IDC Health Insights defines a platform as having
the following elements:
● Development tools, including software development kits (SDKs)
that enable customers and partners to develop new capabilities on
their own on top of the platform to meet current and future
requirements
● Published, upward-compatible application programming
interfaces (APIs) that support bidirectional data flows and user
workflow
● Education for technical staff, in addition to providing end-user
training, that enables them to be more self-sufficient in further
developing and maintaining the solution
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3. ● Broad ecosystem of partners, such as independent software
vendors (ISVs), systems integrators (SIs), channel partners, and
resellers, that extend the platform's reach from both a functional
and a market penetration perspective
● Professional services to support the needs of the ecosystem,
including support for customers and partners customizing the
solution
Platforms evolve over time to meet the needs of customers and
partners in the ecosystem, often through self-development. In contrast,
packaged solutions are designed to meet a very specific set of
requirements. They typically consist of preconfigured, modular
software bundled with well-defined implementation, training, and
support services. Packaged solutions can be extended through Web
services and APIs but lack SDKs. The primary objective of packaged
solutions is to reduce the risk of uncertainty related to project scope,
timelines, and costs.
To be clear, there are advantages and disadvantages associated with
packaged and platform solutions. The definitions are not meant to
imply that one approach is "better" than another. IT buyers should
carefully assess their unique business, technical, and clinical
requirements to determine which approach is appropriate for their
given situation.
Methodology
IDC MarketScape criteria selection, weightings, and vendor scores
represent well-researched IDC judgment about the market and specific
vendors. IDC analysts tailor the range of standard characteristics by
which vendors are measured through structured discussions, surveys,
and interviews with market leaders, participants, and end users. Market
weightings are based on user interviews, buyer surveys, and the input
of a review board of IDC experts in each market. IDC analysts base
individual vendor scores and, ultimately, vendor positions on the IDC
MarketScape, detailed surveys and interviews with the vendors,
publicly available information, and end-user experiences in an effort to
provide an accurate and consistent assessment of each vendor's
characteristics, behavior, and capability.
The sources of information for this report include:
● Vendor briefings. Vendor briefings took place with the vendors
that have products featured in this report.
● Customer references. Interviews were held with customers of the
products covered in the report, including both those references
provided by the vendors and other customer references known to
©2012 IDC Health Insights #HI235816e Page 1

4. IDC Health Insights. At least two detailed, 45-minute reference
conversations were held for each product covered.
● Secondary research. Secondary research for the report included
vendor, user, and product Web sites and blogs as well as existing
IDC Health Insights research covering this market and these
products.
SITUATION OVERVIEW
HIE Drivers and Barriers
Health information organizations have evolved from early regional
health information organizations of the mid-2000s that were primarily
grant-funded pilot projects to HIOs focused on connecting the
enterprise and extended community of medical trading partners to
meet meaningful use requirements and lay the groundwork for value-
based healthcare. Drivers for HIE include:
● Provide clinician access to comprehensive health information.
Greater access to patient health information provides clinicians a
holistic view of their patients and enables clinicians to make more
informed clinical decisions at the point of care.
● Improve patient care and safety. Clinical gaps in care alerts
against evidence-based guidelines and protocols help clinicians
better manage patients with chronic conditions and provide
preventive healthcare services to all patients. Access to health
information recorded by other clinicians, such as allergies and
medication history, helps reduce potential adverse drug events.
● Enhance care team collaboration. The secure exchange of health
information among care team members improves care team
collaboration and leads to more coordinated transitions in care.
● Reduce healthcare costs. Improved patient safety; reduction of
redundant, clinically unnecessary treatments; lower rates of
readmissions; and improved patient outcomes will ultimately lead
to lower healthcare costs.
● Qualify for meaningful use incentive payments. Stage 2 steps up
the requirements for HIE. In Stage 1, providers only needed to
show that they were capable of submitting health information to
immunization registries and public health agencies and could use
test data to do so. Stage 2 requires data submissions to external
entities on an ongoing basis (e.g., summary care records,
immunizations, lab results, syndromic surveillance, patient
information at the patient's discretion and, potentially, medical
images). In addition, 10% of summary care records must be sent to
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5. unaffiliated eligible providers (EPs), eligible hospitals (EHs), or
critical access hospitals (CAHs) using a different EHR system.
● Lay the groundwork for value-based healthcare. Once health
information is available electronically, it can be aggregated and
normalized to become semantically interoperable and analyzed.
Robust business intelligence and analytic tools to measure quality
and outcomes against industry benchmarks will provide the
foundation for population health, care, and disease management
initiatives and identify clinical best practices across the entire
delivery network. By combining clinical and financial health
information, HIOs can measure and monitor clinical, operational,
and financial performance of its accountable care or value-based
healthcare initiatives.
Despite more widespread adoption of EHRs and the intense need to
exchange health information to meet the "triple aim" of health reform
— improve population health, reduce costs, and improve the patient
experience — there are challenges that impede progress:
● Complex set of technologies. HIE technology is not a single
application but instead a set of technologies consisting of a
presentation layer, patient/provider identification, data aggregation,
data integration and exchange, information management, identity
access management, and development framework and extensions.
(See the Solution Components section in the Learn More section
for a more detailed description of the key components that make
up the HIE technology stack.) HIE vendors that cannot provide the
full technology stack have established strategic technology
partnerships to provide a best-of-breed solution.
● Cost. A challenging economic environment and competing IT
initiatives continue to constrain IT budgets. To reduce the total
cost of ownership, HIE vendors are increasingly offering their
solutions on a hosted and/or SaaS basis, leveraging cloud
economics.
● Privacy and security. As more patient information is moved into
EHRs and made accessible both inside and outside the
organization via health information exchanges and a range of
devices, including mobile devices, the risk of a privacy breach
rises. Under ARRA, privacy breach notification, minimum use,
and disclosure reporting requirements become more stringent, and
the total annual penalties for violations can increase to $1.5
million. HIOs that cross state lines must be able to meet each
state's privacy laws, which could require the ability to support both
opt-in and opt-out consent based on where the patient lives and/or
where the care is delivered. Consequently, the privacy and security
model for HIE technology should be carefully evaluated.
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6. ● HIO sustainability (or lack thereof). Over the years, there have
been many notable failures of HIOs that could not survive after the
grant money ran out. Establishing the right revenue model for the
HIO requires a careful evaluation of how stakeholders will derive
value from participating in the HIO as well as what data they want
to consume, what they will be willing to contribute, and what they
will be willing to pay for. Flexible vendor pricing and delivery
models will enable HIOs to incrementally roll out functionality to
demonstrate value early to attract more HIO participants and add
value-added services beyond the core exchange of health
information.
FUTURE OUTLOOK
The IDC Health Insights vendor assessment for platform solutions for
the HIE technology market represents IDC's opinion on which vendors
are well positioned today through current capabilities and which are
best positioned to gain market share over the next few years.
Positioning in the upper right of the grid indicates that vendors are
well positioned to gain market share. For the purposes of discussion,
IDC Health Insights divided potential key strategy measures for
success into two primary categories: capabilities and strategies.
Positioning on the y-axis reflects the vendor's current capabilities and
menu of services and how well aligned it is to customer needs. The
capabilities category focuses on the capabilities of the company and
product today, here and now. Under this category, IDC Health Insights
analysts look at how well a vendor is building/delivering capabilities
that enable it to execute its chosen strategy in the market.
Positioning on the x-axis or strategies axis indicates how well the
vendor's future strategy aligns with what customers will require in one
to four years. The strategies category focuses on high-level strategic
decisions and underlying assumptions about offerings, customer
segments, business, and go-to-market plans for the future, in this case
defined as the next one to four years. Under this category, analysts
look at whether or not a supplier's strategies in various areas are
aligned with customer requirements (and spending) over a defined
future time period.
Figure 1 shows each vendor's position in the vendor assessment chart.
Its market share is indicated by the size of the bubble, and a (+), (-), or
() icon indicates whether or not the vendor is growing faster than,
slower than, or even with, respectively, overall market growth.
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7. FIGURE 1
IDC MarketScape: U.S. Health Information Exchange Platform
Solutions Vendor Assessment
Source: IDC Health Insights, 2012
Vendor Summary Analysis
InterSystems
InterSystems is a privately held software company that serves the
healthcare, financial services, telecom, retail, and manufacturing
industries, among others. Approximately 80% of its revenue is from
healthcare. Founded in 1978 and headquartered in Cambridge,
Massachusetts, the company reported $385 million in revenue in 2011.
The high-speed Caché database represents 80% of that revenue.
Across the entire product line, which includes Caché, Ensemble
integration platform, HealthShare HIE platform, and TrakCare
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8. (inpatient and ambulatory EMRs marketed outside the United States),
InterSystems reports having 80,000 healthcare customers.
HealthShare supports the following HIE services: composite health
record, clinician viewer, patient index, provider directory, terminology
engine, consent management, clinical message delivery, and active
analytics. Customers can use either HealthShare's clinical viewer or
their own portal application to view consolidated patient records.
HealthShare's built-in Caché database lets users directly access data in
their existing applications. HealthShare leverages InterSystems iKnow
and DeepSee technologies to unlock all patient information, including
unstructured data, and to enable real-time analysis.
HealthShare is offered through either a perpetual or a subscription
license.
InterSystems targets large-scale enterprise (IDN based) and regional
and statewide HIEs in the United States. Internationally, InterSystems
targets both private and public HIE networks on a national level.
Developing strong partnerships with customers and technology
vendors is important to InterSystems. The company targets prospects
that are well managed and "know what they want to get done and will
do it."
InterSystems has partnerships with various EMRs. The company also
works with system integrators, such as J2, Infinimed, Inland Imaging,
Intuitive Technical Solutions, Rapidata, Telus, Lucrum, Cognizant,
Orchestrate, Ready Computing, and DS, among others, to help its
customers deploy HealthShare and Ensemble.
According to InterSystems, the company has 43 HIE customers in 5
countries, including 34 customers in the United States (27 enterprise
HIEs, 3 RHIOs, and 4 statewide HIEs in Illinois, Rhode Island,
Missouri, and New York). The remainder are located in EMEA, Latin
America, and APAC. There are 3 countrywide initiatives in the
Netherlands, Sweden, and Denmark and other implementations in the
Czech Republic and Australia.
Notable customers include three of New York's RHIOs and Rhode
Island's statewide HIE. Most recently, HealthShare was selected by
New York eHealth Collaborative (NYeC) as the HIE technology
foundation for the Statewide Health Information Network of New
York (SHIN-NY). The other New York RHIOs are Brooklyn Health
Information Exchange (BHIX), Healthcare Information Xchange of
New York (HIXNY), and Long Island Patient Information eXchange
(LIPIX), now called Healthix. Currently, data is being exchanged for
approximately one-third of the patients expected to be covered by
Healthix. One of HealthShare's largest customers is the Swedish
National Patient Overview (NPO), which selected HealthShare to
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9. create a nationwide electronic health record system covering the
country's 82 hospitals serving 9 million Swedes.
ID C M ar k et Sc ap e As s es sm ent
Based on InterSystems' score in this IDC MarketScape, the company is
positioned in the Leader category.
A key differentiator is that HealthShare is designed from the ground
up using InterSystems technology and is ready to use "out of the box,"
with little need for internal integration. HealthShare incorporates
InterSystems Ensemble, a market-leading integration platform, as well
as Caché, a high-performance database engine. Strong analytics
capability is provided through a combination of DeepSee for active
analytics and iKnow for searching unstructured data.
Customers consistently praise InterSystems' experienced development
and support staff.
HIOs wanting to form strong partnerships with their HIE vendor
should consider InterSystems. Strong customer partnerships are
important to InterSystems, and customers rate InterSystems highly on
its flexibility.
ESSENTIAL GUIDANCE
Actions to Consider
Before beginning the vendor selection process, the HIO should define
the problem it's trying to solve and be able to clearly articulate it first
to stakeholders and then vendors during the search process. This
process will help identify the type of solution desired, thus narrowing
the list of vendors for evaluation to a manageable number and
allowing a more "apples to apples" comparison of potential solutions.
Use this IDC MarketScape to compare vendor offerings.
When evaluating HIE solutions, healthcare organizations should
consider the following:
● What is the origin of the vendor's solution? Despite recent
mergers and acquisitions, the HIE market remains fragmented and
includes vendors that have entered the market from widely
disparate origins. Many HIE solutions have evolved from the
expansion of functionality of products that were originally targeted
at related business functions, such as interfacing internal
applications, workflow management, secure messaging, or Web
portal development. Understanding a vendor's origin can help
guide product evaluation and inform expectations regarding
product strengths and potential gaps to be filled in.
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10. ● Does the HIO want a development platform or a turnkey
solution? HIOs with limited internal IT resources or a need to
deploy quickly should consider turnkey packaged solutions. HIOs
that have unique, complex environments; their own methodology
for technology implementation; and IT resources for deployment
and internal development should consider vendors that provide
infrastructure or platform solutions that enable them to customize
their own HIE solution.
● How important is a vendor-neutral solution? EMR vendors are
also beginning to offer their own HIE solution through
partnerships, acquisition, or internal development. If there is a
dominant EMR vendor in the medical trading area, then using that
vendor's HIE solution may help establish connectivity to its
customers quickly. However, HIOs should recognize that one of
the more challenging aspects of HIE is to get competing EMR
vendors to work together to exchange data between their systems.
As such, they should develop service-level agreements that hold
vendors accountable for any lack of collaboration that delays or
impedes deployment of the HIE.
● Can the vendor and its HIE solution enhance "speed to
value"? The ability to leverage existing systems and accelerate
implementation time frames is the fastest path to HITECH
incentives. What experience does the vendor have in working with
the EHR solutions used by the HIO's medical trading partners?
● How flexible is the architecture? Flexibility is critical to meet the
ever-changing regulatory requirements that will ultimately
transform how healthcare organizations deliver care and are paid
for those services, impacting business, clinical, and technical
requirements for health information exchange. SOA-based
architecture provides technical flexibility that enables vendors and
their customers to respond to new requirements whether they are
imposed to meet new business objectives, standards, or regulatory
mandates.
● Will the data be centralized or federated, or will a hybrid
approach be utilized? The advantages and disadvantages of each
model are discussed in the Solution Architecture section in the
Learn More section. HIOs should evaluate the willingness of
stakeholders to share data and how much sharing will be tolerated
to determine the appropriate strategy. In some cases, HIOs might
find it easier to start with a federated approach to get a proof of
concept up and running quickly to demonstrate value to
stakeholders but then will want to centralize data in order to
provide clinical decision support and population health
management services. These HIOs should seek vendors that
support multiple approaches and query them about what it takes to
migrate from one strategy to another.
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11. ● If data is to be aggregated, how will it be aggregated and how
will it be used? Aggregation strategies vary from storing
documents to discrete data that can be acted upon. The ability to
aggregate data and apply a variety of clinical and business
intelligence, analytics, and decision support tools will be essential
for managing the healthcare organization's performance under new
value-based reimbursement models.
● Can the vendor provide a comprehensive end-to-end solution?
Vendors assemble end-to-end solutions through a combination of
internal development, strategic partnerships, and product or
company acquisitions. It is important to understand how well these
components are integrated, especially if the assets are owned and
managed by separate companies.
● How strong are the vendor's strategic partnerships? Look for
vendors with a track record for establishing and maintaining strong
partnerships with other technology vendors — few, if any, vendors
can provide all the required components.
● What pre- and post-implementation support is available? The
measure of success is determined by the number of users actively
using the system and transaction volumes, not simply the number
of registered users. HIOs should ask the vendors they are
evaluating what type of support is available to market the HIE
solution to clinicians, provide engaging training, monitor ongoing
utilization, and address any barriers to adoption (e.g., provide
additional training because of turnover in the office).
HIOs should follow best practices for system selection including
conducting thorough due diligence. Talk to customers that resemble
the HIO and have similar business needs. Can the vendor support not
only current needs but future business, clinical, and technical
requirements? What is on the vendor's product road map, and how
does that match up to the HIO's evolving needs? Obtain SLAs; does
the vendor have the appropriate staffing (employed or contracted) to
support the implementation and post-implementation phases? If the
HIO is contemplating or has an accountable care initiative under way,
what is the vendor's experience working with ACOs?
Last, remember successful HIE initiatives begin and end with strong
partnerships between the HIE and its stakeholders, between the HIE
and technology vendor(s), and between the technology vendor and its
strategic partners. Open lines of communications and managing
expectations will go a long way to ensuring that the HIE's objectives
are not only met but even exceeded.
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12. Synopsis
This IDC Health Insights report provides an evaluation of 16 vendors
that provide a platform solution for HIE. The vendors we chose to
cover include leaders in the industry that were chosen for their market
share and penetration or their potential growth opportunities.
Additional HIE vendors are covered in IDC MarketScape: U.S. Health
Information Exchange Packaged Solutions 2012 Vendor Assessment
(IDC Health Insights, #HI235830, July 2012), which covers 10
vendors that offer a packaged solution for HIE.
"New care delivery and reimbursement models will require flexible IT
solutions that can address current and future technical, business and
clinical requirements," states Lynne A. Dunbrack, program director,
Connected Health IT Strategies. Platform solutions for HIE provide
the tools to enable HIOs and ecosystem partners to build out new
functionality to meet their constantly evolving needs.
Copyright Notice
Copyright 2012 IDC Health Insights. Reproduction without written
permission is completely forbidden. External Publication of IDC
Health Insights Information and Data: Any IDC Health Insights
information that is to be used in advertising, press releases, or
promotional materials requires prior written approval from the
appropriate IDC Health Insights Vice President. A draft of the
proposed document should accompany any such request. IDC Health
Insights reserves the right to deny approval of external usage for any
reason.
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