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Cranfield, UK, 14th June 2024 – Hello everyone! Lots of interesting announcements this month across EHR and healthcare IT, particularly in relation to the financial performance of public-listed EHR vendors.
EHR Vendor Financials Q1 2024
Epic continues to gain share at every other vendor’s expense, including nearest competitor Oracle Health. Epic was the only inpatient US EHR vendor to grow its net market share in the 2023 financial year, by the end of which it held a 40% share of hospitals (with Oracle Health a distant second with around a quarter share) and around half the share of beds (with Oracle Health again second with around a quarter share).
Where the US inpatient market story is dominated by Epic, things are different in EMEA. Overall, European public inpatient-focused vendor revenues grew by +20% year-on-year, an impressive figure skewed by Comarch Medicine’s 45% year-on-year growth. Nexus AG was another ‘winner’ with 16% growth for the last full 12 months, while CompuGroup Medical SE & Co. KGaA Hospital Information Systems (HIS) business unit revenues were up 13% for the last full 12 months. In its 2023 annual report, Nexus referred to changes in Oracle and SAP’s healthcare offering in Germany and the Netherlands as providing ‘numerous opportunities’ for its own future sales development. This is related to Oracle Health’s i.s.h.med EHR software which SAP will no longer support by 2030. There are already instances of i.s.h.med customers making the switch to Nexus and other EHR vendors, particularly leading vendors in Germany and the Netherlands (e.g. ChipSoft, Epic, Dedalus, CGM).
The latest European financial results demonstrate, as predicted at the start of this year, the impact that large-scale hospital IT infrastructure investments – such as the €3.4B Germany Hospital Futures Act (KHZG), €1.1B-worth of EMR, imaging and telehealth tenders issued in Italy, the rollout of a second Digital Health Roadmap in France and an aggressive hospital EHR investment programme in the UK – are having on vendors in EMEA.
Click here to read Mark Lazell’s full critique of public-listed EHR vendors in the US and EMEA, in this SPI Digital Health insight.
Oracle Health Nashville Summit
Three main themes emerged from Oracle Health’s recent summit in Nashville. Rather than dwell on the much-publicised issues that have dragged on the company’s reputation, its bottom line and its workforce, the vendor chose aspirational topics: data interoperability, cybersecurity/data privacy capabilities, and its stance on healthcare ecosystem automation.
Much was made of how Oracle Health’s global footprint and access to data (e.g. through gene sequencing for precision medicine) could support global public health initiatives, for example, future pandemic responses. It also referenced the high profile cyberattack suffered by US revenue cycle management systems vendor Change Healthcare earlier this year. While not directly criticising the security of Change Healthcare’s Amazon Web Services (AWS) cloud platform that was breached, it was implied that this could never happen with Oracle’s autonomous digital infrastructure (ADI).
A leaked internal memo made public provided a backdrop to the Nashville summit. The document alleges that company revenue for FY2023 (which in this company’s case unusually runs from 1 June 2023 to 31 May 2024) was set to fall by 5% to $5.6B, then stay flat for FY2024 before turning a corner in 2025. The leaked source also alleged that at least a dozen major customers had replaced their Oracle Health software in 2023, a worrying trend. Oracle Health is ploughing huge resources into halting the erosion. It’s likely to succeed, but not anytime soon. Click here to read the SPI Digital Health insight.
Three Acute Hospital Alliance Trusts to Benefit from New Shared Electronic Record
There was some positive news for Oracle Health in May as it was selected by NHS England (NHSE) to deliver a new shared Electronic Patient Record (EPR) across three trusts that form the Acute Hospital Alliance; Salisbury NHS Foundation Trust, Great Western Hospitals NHS Foundation Trust and Royal United Hospitals Bath NHS Foundation Trust. The aim is to go live across the three trusts during 2026.
An investment of £1.9bn is being provided to NHS trusts, through the NHSE’s frontline digitisation programme, to ensure EPRs are in place. Although a November 2023 guidance letter suggested that investment may be pulled from all except the least digitised trusts.
To date, there’s been significant progress with the EPR rollout, with most NHS hospitals having EPRs in place and only a smaller number remain without one. Signify Research believes emphasis must shift towards extending the rollout to departmental IT. It’s one thing to have an EPR, but it’s another to be able to digitise processes in ICUs, emergency departments, operating rooms, anaesthesia departments, etc. which currently have a fragmented patchwork of EPRs, standalone departmental IT solutions and, in some cases, paper.
In March 2024, £3.4B ($4.3B) was allocated to the NHS for IT infrastructure and digitisation. While the government stated that part of this investment will include digitising operating theatres, moving towards a fully integrated IT solution so that hospitals can remove the smaller pockets of disjointed IT or paper systems must be a goal.
First Pilot Sites Unveiled for NHS Federated Data Platform
Kettering General Hospital NHS Foundation Trust and Northampton General Hospital NHS Trust, which form the University Hospitals of Northamptonshire NHS Group (UHN), are the first of 44 pilot sites transitioning to a local instance of the NHS Federated Data Platform (FDP).
The FDP is intended to aggregate and interrogate anonymised and non-anonymised data from different EHRs and IT systems across ICSs, Acute Trusts and other providers in England (though, significantly, not GP data directly from primary care EHRs). The NHS claims the FDP will reduce the time NHS staff spend chasing referrals, scheduling appointments and waiting for test results.
However, the FDP will not be compulsory. NHS Trusts and ICSs will be encouraged to use it to support their own use cases, however, it is difficult to see how many will actually do so. ICSs are already spending nearly half a billion dollars on the ICS rollout. FDP also creates confusion because it effectively does the same as many of the ICS solutions, but on a national rather than regional level.
In December 2023, a heavily redacted version of the contract was issued by NHSE, covering the first three years of FDP to Feb 2027, with a total value of £182m ($230m). However, an update in March 2024 suggested the contract value could increase to a forecasted amount of £330m ($480m). The latest analysis covering health information exchange trends is unveiled in my recent HIE – World – 2024 report.
CLEW Obtains FDA Approval for Next-Gen AI solution
AI-driven clinical surveillance and predictive analytics vendor, CLEW, recently received FDA clearance for its next generation tool for predicting patient deterioration. This builds on its claim to be the first FDA-cleared Class II medical device back in 2021. The CLEW system proactively identifies high-risk patients up to eight hours before physiological signs and other monitoring systems would indicate. CLEW’s model can also be deployed beyond the ICU in all inpatient settings. This will allow the vendor to penetrate hospital departments including general wards (where teleICU can be used in conjunction with analytics tools to monitor high-risk patients and prioritise treatment for those with escalating conditions to avoid them entering the ICU), EDs, step-down wards and neonatal ICU.
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About the Author
Arun joined Signify Research in 2019 as part of the Digital Health team focusing on EHR/EMR, integrated care technology and telehealth. He brings with him 10 years’ experience as a Senior Market Analyst covering the consumer tech and imaging industry with Futuresource Consulting and NetGrowth Consultants. Prior to this he worked for Nortel Networks. In his spare time, Arun has a passion for playing sports, supporting Manchester United, and entertaining his two children.
About the Digital Health Team
Signify Research’s Digital Health team provides market intelligence and detailed insights on numerous digital health markets. Our areas of coverage include electronic medical records, telehealth & virtual care, remote patient monitoring, high-acuity clinical information systems, patient engagement IT, health information exchanges and integrated care & value-based care IT. Our reports provide a data-centric and global outlook of each market with granular country-level insights. Our research process blends primary data collected from in-depth interviews with healthcare professionals and technology vendors, to provide a balanced and objective view of the market.