The document summarizes leading physician practice vendors ranked by number of eligible provider (EP) electronic health record (EHR) attestations reported by the Office of the National Coordinator for Health Information Technology (ONC) as of July 2016. It provides details on the history, products, employee and client numbers, revenue, application ratings, and future prospects of the top 6 vendors: 1) Epic, 2) Allscripts, 3) eClinicalWorks, 4) NextGen Healthcare, 5) GE Healthcare, and 6) Cerner.

1. 2017 Physician Practice Vendors
• Top 10 physician practice vendors
- Ranked by # of Eligible Provider
(EP) EHR attestations reported by
the ONC as of July 2016.
• For each vendor:
- H.I.S.-tory
- Products
- # of FTEs
- Client base
- Annual revenue
- Application rating
- Future Prospects
© 2017 HIS Professionals, LLC
Elise Ames
&
Vince Ciotti
HIS Professionals, L.L.C.

2. © 2017 HIS Professionals, LLC
Summary of Leading Vendors By EMR Attestations
• Since most of the 785 physician practice vendors are privately held with no available
revenue figures, we used data published by ONC, which is current as of July 2016.:

3. • Overview – Leading the pack for physician attestations is Judy’s
amazing non-marketing machine (ever read a press-release
issued by them?) that sold almost every large AMC & IDN practice for years.
– Epic dominates in both the large hospital and large MD practice niches.
Their revenue rose 23% from $2B in 2015 to $2.5 billion last year.
– Epic’s integrated HIS/MD system is installed primarily at hospital-owned
or very large (50+ MD) physician practices. They lead the physician pack
with over 83K attestations by EP users reported by the ONC for 2016.
– Provider satisfaction with Epic systems is very high – two of the most
admired features are the complete integration of the practice EHR with
the EpicCare hospital system, and the ease of exchanging clinical
information between providers in their network (other Epic users).
– Epic’s participation (or lack of) in facilitating vendor-neutral, standards-
based data had been a hotly discussed topic over the past few years,
however Epic’s re-stated commitment to interoperability appears to be
backed up by recent action, mainly the widespread adoption of
CareEverywhere and their participation in the Carequality initiative.
#1 =

4. • HIS-tory – founded by CEO Judy Faulkner in 1979 in Madison, as HRC (Human
Resources Computing). Initially wrote systems for diverse industries, but soon
specialized in healthcare, first MD practices then hospitals, with the first truly
integrated HIS/MD system, written in InterSystems’ “Cache” db/language.
• Product Lines – only one product: “EpicCare,” an integrated hospital and
physician practice system. We have interviewed dozens of users in numerous
IT Assessments conducted over the years, and most physician users are
extremely pleased with Epic. Indeed, happy physicians are probably the “back
door” that enables Epic to convert so many large AMCs & IDNs to EpicCare!
• Stats – approximately 9,500 employees as of January 2016
• Client base – about 380 contracts representing mostly large IDNs and AMCs,
• Rating by application – strong on both sides of the equations: hospitals and
practices, clinical and financial, with a wide array of ancillary systems too.
- Only gap: no ERP system, either self-developed or through partners.
• Future Prospects – as solid as Wisconsin’s frozen lakes! They win almost every
large AMC and IDN selection (outside of Siemens’ clients), with but a few
exceptions: the DoD (Leidos/Cerner) and Intermountain Healthcare (Cerner).
Details

5. • HIS-tory – Founded in 1986 as a medication company, Allscripts brought
one of the first e-prescribing products to market in 1994. Current products
in the hospital, physician, and post-acute care marketplaces were all
obtained through many acquisitions – no products were self-developed.
Biggest acquisition was Eclipsys’ “Sunrise” HIS/MD system, followed by.:
- dbMotion (HIE & data analytics)
- Jardogs (personal health)
- Netsmart (behavioral health)
- CarePort (population health)
To support strategic expansion into overseas markets, Allscripts also
acquired Oasis Medical Solutions (a UK based EHR company) in 2014 and
Core Medical Solutions (an Australian HIT company) in 2016.
• Product Lines – 33K MD attestations from their “TouchWorks” (formerly
“Enterprise”) for large practices, “Professional” for medium and small
practices, and “Sunrise Ambulatory Care” for ≈30 large practices affiliated
with hospitals running the fully integrated Sunrise HIS/MD system.
#2 = (NASDAQ: MDRX)

6. • Key Stats – approximately 7,600 FTEs as of year end 2016. FY2016
revenue was $1.5B, a solid 12% increase from 2015.
• Client base – Allscripts claims 45,000 practices and 180,000 physician
users in the US across all of its many products.
• Rating by application – Allscripts was the first EHR vendor to certify an
ambulatory EHR to ONC’s 2015 standards, so their products are being
enhanced and updated well, despite their growing age & diversity.
• Future Prospects – Touchworks should compete well for large physician
practice sales against major competitors eClinicalWorks, athenahealth and
NextGen, just as Professional is doing well against the many smaller
vendors, even though many offer newer and less expensive products.
Sunrise has the biggest challenge selling against Epic, Cerner and now
Meditech’s Release 6 to hospitals seeking integrated MD/HIS systems…
Although US sales growth has been relatively flat over the past several
years, Allscripts has done well internationally (e.g.: Australia), retains a
large customer base of all size practices, and maintains a solid and growing
revenue stream from selling support and services to existing clients.
#2 = cont’d

7. • HIS-tory – Privately held, eCW was founded in 1999 in Westborough, Mass.
• Product Lines – eCW sells a single, self-developed PM/EHR product named
“10e” for physician practices, both direct & through re-sellers. Also eCW is
marketing a population health solution (who isn’t?) called CCMR.
• Stats – 25K attestations, 4,500 employees and ≈$440M in revenue for 2016
(excluding resellers) – approximately a solid 10% growth from 2015
• Client base – Claim 75K providers in mostly small practices due to low startup
costs (per-provider, per-month fees), but now in several large organizations
as well through deals with NYCHHC, the NFL, and Walmart.
• Rating by application – the PM/EHR system is highly usable with high ratings
among physicians, while CCMR is gaining traction in the ACO world.
• Future Prospects – Bright and shining in the physician market. eCW’s entrée
into the HIS market in the US may be challenging in the short term: their
“10i” inpatient system is being developed at 3 pilot hospitals. The inpatient
EHR is completely integrated with eCW’s ambulatory system - comprising a
unified, comprehensive EMR that is in the (eC)works, is due for completion by
2018.
# 3 =

8. #4 =
• HIS-tory – Founded as Quality Systems Inc. in 1994 as a dental software company.
Through a series of mergers and acquisitions (Clinitec, Micromed…), they were re-
branded as NextGen in 2001. In 2009 they entered the HIS market by purchasing
Opus’s EMR & Sphere’s financials, adding small hospitals (mostly CAH) clinical and
financial systems respectively to their client base. However, in subsequent years they
couldn’t sell them well and sold both to Harris Healthcare (QuadraMed) in 2015,
leaving the HIS market. In 2013 NextGen acquired the interface engine formerly known
as Mirth. The recent purchase of HealthFusion and it’s cloud-based, mobile-device-
enabled “Medi-Touch” system provides NextGen with a simpler offering for small
practices.
• Products – Prior to the acquisition of Medi-Touch, NextGen focused on a single
physician product, with an integrated PM and EHR system. NextGen also offers
business analytics and integration tools (Mirth interfaces) as well as RCM outsourcing.
• Stats – ≈3,000 FTEs, generating $492M in annual revenue from ≈20K attestations.
• Client base – Large, mostly independent practices, and specialty practices
• Rating by application - mature products, very configurable, good specialists content.
• Future Prospects: NextGen continues to be financially strong and should continue to
be an MD leader, especially if Medi-Touch helps them expand into small practices…
(NASDQ: QSII)

9. • HIS-tory: Formed in 1892 (older than Invision!), GE has been in healthcare
forever through electronic devices like patient monitors. Their “Centricity”
physician practice products descended from the “Logician” EHR (purchased
2002) and Millbrook PM (acquired 2003). In 2005 GE purchased IDX,
acquiring their leading GroupCast and FlowCast PM physician systems.
• Products: Centricity EMR & Practice Solutions. Centricity EMR is sold as a
standalone interfaced to other vendor’s PM systems. There are 4-5 major
resellers throughout the US.
• Stats: GE Healthcare = $18.3B in 2016, with healthcare systems accounting
for 70% of revenue for the sector; ≈17K ONC attestations.
• Client Base: large/mid-size independent practices (not IDNs), FQHCs
• Rating by App:
– Pros = flexible, good reporting, strong support, corporate stability, integrated
financial/clinical database (Centricity Practice Solutions), integration with GE medical
devices.
– Cons = the relatively expensive EHR is complex to configure.
• Future Prospects: Thanks to its large MD client base, GE Healthcare will
probably not sunset the current physician products for some time...
# 5 = (NYSE: GE)

10. #6 =
• HIS-tory - Founded as “PGI” by Neal & Co. in 1979, Cerner was originally
an LIS specialty vendor, competing so well in that niche they expanded
into hospital clinical systems in the 90s, and then entered the Revenue
Cycle Management (RCM) markets with their “ProFit” system in the early
2000s.
• Product Lines - Like Epic, Cerner’s “PowerChart Ambulatory” EHR is
installed mainly in large hospital-owned physician practices that run
Cerner’s “Millennium” HIS. They offer two systems depending on size:
– “Specialty Practice Management” for practices of 10 or less physicians
– “PowerWorks Practice Management” for practices with 10 or more.
• Stats – 24,400 FTEs generated $5B in revenue, with ≈15K attestations.
• Future Prospects – Although a huge presence in hospitals, they have far
fewer using their clinic EHR and RCM system than MD leaders like Epic and
Allscripts. They will add more physicians through hospital-owned practices
in the hundreds of Siemens clients they are converting from Soarian,
Invision and MedSeries4, although their systems are far more functional
and well-received in hospital versus than physician practice settings...
(NASDQ: CERN)

11. #7 =
• HIS-tory – Founded in 1997 by Jonathon Bush (yes, he’s related to them…)
and Todd Park as a medical practice specialty vendor, today athenahealth is a
highly-successful, publicly traded company, recently entering the HIS market.
• Product Lines – include RCM management services, document management
services, and cloud-based PM/EHR systems, which are uniquely priced as a %
of a practice’s cash collections. This low up-front capital cost model has been
very attractive to cash-strapped physician practices. In 2015 athena bought
HIS vendor RazorInsights, running in 25 Critical Access Hospitals, rewrote it in
an integrated mode as “One,” claiming over 90 sales already.
• Stats – 5,300 FTEs grew revenue 12% in 2016 to $1.08B, with ≈14K attests.
• Client base – claims 75,000 providers, mostly midsize & large practices
• Rating by application – Very tight integration between the physician practice
EHR and PM. Their PM system “athenaCollector” received a 2017 best in
KLAS award for PM systems in the 11-75 physician practice category.
• Future Prospects – A huge potential! Athena’s entry into the hospital market
with an integrated HIS & MD practice system is a potential game changer if
the 90 early sales are implemented well and provide good references...
(NASDQ: ATHN)

12. #8 =
• HIS-tory – Complicated: Greenway Medical Technologies was founded in 1998,
and Greenway Health was formed in 2013, uniting Vitera Healthcare Solutions,
SuccessEHS, and Greenway Medical Technologies. Greenway has a new CEO as of
April 2016: Scott Zimmerman, who replaced co-founder Tee Green.
• Products Lines– PrimeSuite PM/EHR (targeted primarily at small specialty
clinics), SucessEHS PM/EHR (for community health centers and FQHCs), Vitera
Intergy EHR, EDR (dental EHR), as well as RCM outsourcing services.
• Stats – 1,900 FTEs generated $370M revenue with ≈12K attestations.
• Client base – As of 2017, Greenway claimed 75,000 individual practitioners at
approximately 10,000 organizations using various Greenway products.
• Rating by application – Their “PrimeSuite” PM/EHR is highly usable and has
strong ratings among specialists; Intergy is somewhat dated. Numerous partners
for specialized applications e.g. Light beam Health Solutions for population
health, RelayHealth for HIE and Chiron Health for telemedicine integration,
• Future Prospects – positive thanks to their strong focus on interoperability and
chronic care, although there are no sign of plans for an HIS system (yet)…

13. #9 =
• HIS-story: Practice Fusion was founded in 2005 by Ryan Howard and
Jonathan Malek. The company is unique in offering a cloud-based version
small practice EMR & PM at no charge to providers! Revenue is generated
primarily from ads, many from Practice Fusion’s numerous private investors.
• Product Lines – A cloud-based EHR (there’s ads up there too…) and practice
management, along with e-prescribing, mobile device connectivity, and
business analytics. Fusion Connect is their HIE offering that connect practices
with labs, hospitals and other data sources.
• Stats – 300+ FTEs, annual revenue not disclosed; ≈8K attestations.
• Client base – claim 35,000 facilities, mainly small and mid-size practices.
Practice Fusion also markets solutions for standalone labs and imaging
centers.
• Rating by application – System is simple and intuitive, gaining popularity.
Providers don’t seem turned off by the ads, which are relatively unobtrusive.
• Future Prospects – recent 2016 layoff raises some questions, but based on
the companies’ growth since 2007, the business model is solid for now.

14. #10 =
• HIS-tory – Their HIS was born in 1974 by Walt Huff & Co as HBO, a
minicomputer pioneer, which grew through countless acquisitions to be the
#1 HIS vendor by 2000, when acquired by pharm giant McKesson.
• Products – Just as with its HIS products, HBO/McKesson acquired numerous
physician PM and EHR systems over the years, with a total of 7K providers
attesting with them as the primary EHR in 2016 on 9 different products:
– 3 for Small (<10 MDs): Practice Choice (cloud-based), Medisoft, and LytecMD
– 4 for Medium (10-25 MDs): Medisoft, LytecMD, PracticePartner, & Integreat
– 2 for Large (25+ MDs): PracticePartner and Integreat (sic)
• Paragon – During VP Jim Pesce’s reign which ended in 2015, they had
admirable plans to add a fully integrated HIS/MD system written in
Microsoft’s Windows & SQL data base to their “Paragon” HIS system.
– They completed the integrated RCM module last year, but the
integrated EHR system has been pushed back to 2017/2018.
• Prospects - In 2016, McKesson sold most of the above MD systems to eMDs,
a leading physician practice vendor, with 55K physician clients. McKesson is
selling their HIS product line as well, so as the Brits say: “Tata for now…”
(NYSE: MCK)

15. Next Week
 In our final episode, we’ll wrap up our review of MD vendors with:
• - Overview of the next 40, and other 735 vendors
• - HIS vendor “crossover” products
• - Product positioning by practice size
• - Various rating sources
 Please send any questions or comments to:
- Elise Ames
- 413.329.6925
- eames@hispros.com
• Direct your attorneys to:
- Vince Ciotti
- 505.466.4958
- vciotti@hispros.com