1) NextGen was formed through a series of acquisitions and mergers over 4 decades. It began as Quality Systems Inc. (QSI), founded in 1973 developing dental software. 2) QSI later acquired Clinitec in 1996 to enter the EMR market, and MicroMed Healthcare Information Systems in 1997 for its practice management software, combining them as NextGen. 3) The document previews that NextGen would become a major hospital information systems vendor through acquiring three additional companies - Sphere founded by Florian Weiland in 1984, Opus founded by Tim Rhoads and Fred Beck in 1987, and IntraNexus founded by Rick Opry in 1992.

1. H.I.S.-toryby Vince Ciotti
Episode #79: NextGenPart 1
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© 2012 by H.I.S. Professionals, LLC, all rights reserved.

2. 6th of Today’s Leading HIS Vendors
• This week we begin the 6th episode on today’s
HIS vendors: NextGen, whose 2011 annual
revenue places them right behind Meditech:
- $3.2B = McKesson, née HBOC = Walt Huff, Bruce Barrington, & David Owens
- $2.2B = Cerner, still run by Neal Patterson, co-founded with Cliff Illig
- $1.7B (est) = Siemens, née SMS: Jim Macaleer, Harvey Wilson & Clyde Hyde
- $1.4B = Allscripts, née Eclipsys, also founded by Harvey Wilson of SMS.
- $1.2B = Epic. Gee, I have to wonder, just who was it who founded them?
- $900M (est) - GE Healthcare, née IDX/PHAMIS: created by Malcolm Gleser
- $545M = Meditech, still run after all these years by AntoninoPapallardo
- $353M = NextGen: née Quality Systems Inc. founded by Sheldon Razin
- $174M = CPSI, founded by M. Kenny Muscat & Denny P. Wilkins (who??)
- $170M = QuadraMed, née Compucare, founded by Sheldon Dorenfest
- $160M = Keane, parent giant by John Keane, but HIS div. built by Ray Paris
- $110M = HMS (Healthcare Management Systems), Tom Givens & John Doss
- $70M (est) = Healthland, formerly Dairyland, founded by Steve Klick

3. A Complicated Family History
• Actually, I wish the HIS-tory of NextGen was as
simple as that graphic on the title slide implied!
• In fact, it is the convoluted story of a half-dozen
assorted HIS vendors over the past 4 decades.
• Time doesn’t allow the full story of all the firms
acquired such as H.S.I. and P.M.P. of Hunt Valley…
• So we’ll just cover the 4 biggest of the “Previous-
Gen” firms that got acquired/merged over time
and that have the most impact on hospitals today.
In chronological order of their founding, they are:
- QSI, founded by Shelly Razin way back in 1973
- Sphere, founded by FlorianWeiland in 1984
- Opus, founded by Rhoads & Beck in 1987
- IntraNexus, founded by Rick Opry in 1992

4. A Bit “Long In The Tooth...”
• The story of QSI takes us way back 4 decades ago
and into another niche in HIT systems: dentistry.
• QSI’s founder, Sheldon Razin, cut his teeth (so to
speak) in technology at MIT where he got his BS in
math (ironic that he didn’t meet Neal Papallardoand
company there or he might have joined Meditech!),
then started working for Rockwell International.
• He next formed Quality Systems in the early 70s,
with $2,000 of his personal funds, developing
software for commercial and space applications.
• Selling space systems was hard as pulling teeth,
so he tried simpler systems for dentists, whose
practices then were as paper-driven as hospitals
• We won’t drill-down any more into dentistry as
my annual exam is coming up and I get nervous…

5. Growth, IPO & First Acquisitions
• There must have been a large cavity
in the dental system market which
Shelly filled rapidly, capping QSI’s
success by going public in 1980
(that’s him in the middle on left).
• QSI’s market cap (right) grew equally
well preparing the firm for a number
of subsequent acquisitions and
mergers, starting in 1996 with:
- Clinitec– which was formed by Pat Cline (pictured on
the left) and Bryan Rosenberger (both since retired
in1993 to sell software for converting MD practice’s
paper charts into electronic medical records, at a
time when the term EMR didn’t even exist yet!

6. Next Target…
• QSI next set its sights on a Practice
Management System (why doesn’t anyone
ever use the simple acronym “PMS”?) to
complement Clinitec’sEMR for physicians.
• The firm they targeted was led by a talented individual who is still
with QSI to this very day: Tim Eggena, pictured above. His brief bio:
• 1990 graduate of Auburn S.C. where he started in the College of
Business as a finance major, but ended with a degree in MIS.
• His first job was in nearby Atlanta at… (are you ready for a
shock?) some local software firm named “Gerber-Alley”!
• What a small HIS world, no? Anyway, Tim tired
of G-A’s green-screen, mini-based HIS andjoined
a group of young G-A programmers meeting on
weekends to design a system for the red-hot PCs
flooding the market. The group fizzled ≈1993…

7. Birth of:
• Tom knew the CIO at Bayfront Medical Center in St. Pete, FL, and
she inquired about a PMIS (yeah, I’m chicken too...) for PCs.
• Tim and Steve Puckett (CTO today) formed MicroMed Healthcare
Information Systems to write a scheduling system in Windows
(probably 3.1 – back then Gates was still stealing ideas from
Apple’s for Windows ‘95……), which went live at Bayfront in 1994.
• Through word of mouth, MicroMedsold several more practices
and started building their total PMIS: Reg., Sched., BL and AR. Tim
and Steve needed capital to continue growing and debated an
IPO, being acquired, or merging with a larger firm. The answer:
• QSI acquired them in 1997 as
their PMIS, to combine with
CliniTec’sEMR to create a total
solution, which they named
around 1999 as “NextGen.”

8. Next Week…
• So that’s how QSI started in dentistry
software, and ended up as a leader in
the physician practice market with
their “Next Generation” combination
of CliniTecand MicroMed
• So what’s this got to do with Hospital
Information Systems you ask?
• Stay tuned for next week as we cover
the three HIS vendors QSI acquired
next that now make NextGen as major
a player in the HIS market as in PMIS:
- FlorianWeiland’sSphere
- Tim Rhoads & Fred Beck’s Opus
- Rick Opry’sIntraNexus